基于BNP和IL-6的列线图模型在预测老年髋部骨折患者术后主要不良心血管事件发生风险的价值

The value of nomograph model based on BNP and IL-6 in individualized prediction of the risk of postoperative adverse cardiovascular events in elderly hip fracture patients

目的探讨基于脑钠肽(BNP)和白介素-6(IL-6)的列线图模型在个体化预测老年髋部骨折患者术后主要不良心血管事件(MACE)发生风险的价值。方法纳入2016年1月—2022年12月新疆医科大学第一附属医院创伤骨科诊治老年髋部骨折患者234例作为建模集,同期纳入新疆医科大学第六附属医院收治的老年髋部骨折患者253例作为验证集。以建模集老年髋部骨折患者术后30 d内是否发生MACE分为MACE组37例(15.8%)和N-MACE组197例(84.2%),比较建模集2组患者临床资料、实验室指标、心功能指标以及手术相关指标,多因素Logistic回归分析获得影响老年髋部骨折患者术后发生MACE的独立预测因素,并构建列线图模型,绘制校准曲线和ROC曲线,进一步分析列线图模型的预测效能和准确度。结果多因素Logistic回归分析调整和校正混杂因素后,ASA分级高、年龄≥70岁、BNP高以及IL-6高为老年髋部骨折患者术后发生MACE的独立危险因素[OR(95%CI)=2.576(1.243~4.567),2.317(1.237~4.347),2.467(1.214~3.598),2.389(1.208~3.672),P均<0.05];基于4个独立预测因素:ASA分级、年龄、BNP及IL-6,构建预测老年髋部骨折患者术后MACE发生风险的列线图模型;校准曲线显示,建模集和验证集老年髋部骨折患者术后MACE发生风险的预测值与实际观测值符合度良好(P>0.05),ROC曲线分析结果显示,建模集联合预测的曲线下面积(AUC)为0.923(95%CI 0.882~0.967),验证集联合预测的AUC为0.903(95%CI 0.876~0.958)。结论基于BNP和IL-6的列线图模型可用于准确预测老年髋部骨折患者术后MACE发生风险。

Objective To explore the value of the nomogram model based on brain natriuretic peptide(BNP)and interleukin-6(IL-6)in the individualized prediction of the risk of postoperative major adverse cardiovascular events(MACE)in elderly hip fracture patients.Methods Two hundred and thirty-four elderly hip fracture patients admitted to author’s hospital from January 2016 to December 2022 were included as the modeling set,while 253 elderly hip fracture patients admitted to orthopedics department of the Sixth Affiliated Hospital of Xinjiang Medical University were included as the validation set.Elderly hip fracture patients in the validation set who experienced MACE within 30 days after surgery were divided into the MACE group of 37 cases(15.8%)and the N-MACE group of 197 cases(84.2%).The general clinical data,laboratory indicators,left ventricular ejection fraction and surgery related indicators of patients between the two groups in the modeling set were compared,the statistically significant variables in the single factor analysis were included in the multivariate Logistic regression analysis to obtain the independent predictors of MACE in elderly hip fracture patients after surgery,the analysis was focused on the predictive value of BNP and IL-6,and a nomogram model was constructed,calibration curve and ROC curve were drawn to further analyze the predictive performance and accuracy of the nomogram model.Results Multivariate Logistic regression analysis adjusted for confounding factors,ASA grade,age,BNP and IL-6 were still independent predictors of postoperative MACE in elderly hip fracture patients[OR(95%)CI=2.576(1.243-4.567),2.317(1.237-4.347),2.467(1.214-3.598),2.389(1.208-3.672),P<0.05];A nomograph model was constructed to predict the risk of postoperative MACE in elderly hip fracture patients based on four independent predictors:ASA grade,age,BNP and IL-6;The calibration curve showed that the predicted value of postoperative MACE risk of elderly hip fracture patients in the modeling set and the validation set were in good agreement with the actual observation value(P>0.05).The ROC analysis results showed that the area under the curve(AUC)of jointly prediction in the modeling set was 0.923(95%CI 0.882-0.967),and the AUC of jointly prediction in the validation set was 0.903(95%CI 0.876-0.958).Conclusion The nomograph model based on BNP and IL-6 can be used to accurately predict the risk of postoperative MACE in elderly hip fracture patients.